感染性心内膜炎活动期急诊手术临床分析.docVIP

感染性心内膜炎活动期急诊手术临床分析 　【摘要】 目的 探讨危重感染性心内膜炎患者的手术指征、手术时机及手术方式的选择，观察其手术效果和术后恢复情况，总结其临床治疗经验。 方法 1999年2月至2006年2月共完成危重感染性心内膜炎急诊行体外循环心内直视手术病例13例，包括主动脉瓣置换8例、二尖瓣置换2例、联合瓣膜（二尖瓣+主动脉瓣）置换3例，同期行三尖瓣成形5例、室间隔缺损修补、主动脉窦动脉瘤修补各1例，未闭动脉导管缝闭3例。所有人工瓣膜均为机械瓣。 结果 早期死亡1例，余均经手术及抗生素治疗后临床痊愈出院。术后随访心功能I级5例、II级6例，无心内膜炎复发。结论 虽然感染性心内膜炎在活动期急诊手术的病死率、术后并发症和复发率均较稳定期的择期手术明显增高，但当出现药物治疗难以控制和/或心功能进行性下降等情况时，应果断施行手术以挽救患者的生命。选择手术时机的主要依据，应视心功能变化的状态，而应用抗生素治疗的时间仅能作为一个参考因素。 【关键词】 感染性心内膜炎 外科治疗 回顾性分析 【Abstract】 Objective To provide an overview of surgical treatment of the active infective endocarditis cases, mainly on the surgical indication, the timing of surgical treatment, the methods of operation, and to observe the outcome for experience summary. Methods Surgical treatment of 13 cases with serious infective endocarditis between January 1999 and January 2006 was analyzed retrospectively, including 8 cases of aortic valve replacement,2 cases of mitral valve replacement,3 cases of combined aortic and mitral valve replacement,5 cases of tricuspid valvuloplasty. At the same time, maneuvers were done to the original heart defects e.g. One case with ventricle septum defect, one case with aortic sinusal aneurysm and three cases with patent arterial duct.All valves of implantation were mechanical. Results There was one early death, the others discharged successfully because of the operation and the usage of antibiotic. The outcome of the patients shows substantial improvement in functional performance and clinical status. Post operative cardiac classification(NYHA):classⅠwas in 5 cases, classⅡ in 6 cases. There was no recurrence of infection. Conclusions Although the mortality, the rate of complications and recurrence are high in active patients with infective endocarditis, when intractable heart failure and incontrollable infection occur in the patients complicated with primary cardiac lesions, urgent surgical intervention is necessary to save the life of patients. For the patients with cardiac valve lesions, the choice of t